Provider Demographics
NPI:1821750654
Name:PACHECO RAMOS, WANDA (RN)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:PACHECO RAMOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 AVE MARUCA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-4103
Mailing Address - Country:US
Mailing Address - Phone:787-812-5978
Mailing Address - Fax:787-812-5966
Practice Address - Street 1:2706 AVE MARUCA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-4103
Practice Address - Country:US
Practice Address - Phone:787-812-5978
Practice Address - Fax:787-812-5966
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR71765163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty